In Malaysia, the National Breastfeeding Policy recommends exclusive breastfeeding for the first six months of life and continued up to two years. Since the 1990s, several breastfeeding promotion programmes had been implemented in the country. This article reports the findings on the prevalence of breastfeeding practice from The Third National Health and Morbidity Survey (NHMS III) which was conducted in 2006. A total of 2167 mothers or carers of children below two years old were interviewed representing 804,480 of the estimated population of children aged below 2 years in Malaysia. Respondents were asked whether various types of liquid or solid food were given to the child at any time during the preceding 24-hour period. The overall prevalence of ever breastfed among children aged less than 12 months was 94.7% (CI: 93.0 - 95.9). The overall prevalence of exclusive breastfeeding below 6 months was 14.5% (CI: 11.7 - 17.9). Prevalence of timely initiation was 63.7% (CI: 61.4 - 65.9) and the continued prevalence of breastfeeding up to two years was 37.4% (CI: 32.9 - 42.2). The findings suggest that the programmes implemented in the last ten years were effective in improving the prevalence of ever breastfeeding, timely initiation of breastfeeding and continued breastfeeding up to two years. However, the challenge is to improve exclusive breastfeeding practice. Longterm community-based interventions need to be carried out in partnership with the existing health care system, focusing on discouraging the use of water and infant formula, especially in the first few months of life.
Study name: National Health and Morbidity Survey (NHMS-2006)
The study was conducted to assess the level of understanding and the ability to extract information from a nutrition information panel (NIP) among women (n = 232, 20-59 years) in the Klang Valley, an urban area in Malaysia. The study involved the currently used format in Malaysia and three other formats, namely (i) based on Guideline Daily Amount (GDA), (ii) Multiple Traffic Light (MTL) and (iii) combination of GDA/MTL. Four hypermarkets were chosen for the face-to-face interview using a questionnaire. Subjects were selected using a convenient sampling method. The mean score for level of understanding was the highest for the current format (3.46 ± 1.12) compared to the other three tested formats (GDA = 3.09 ± 1.03, MTL = 2.72 ± 0.97, GDA/MTL combination 3.09 ± 1.36). However, most of the respondents (68.1%) would prefer the current NIP format to be changed due to difficulty in understanding (43.1%) and perceived the nutrition information to be insufficient (23.3%) and over simplified (21.6%). When other NIP formats were introduced, GDA format was the most preferred (mean score 3.52 ± 0.84) compared to the other formats (MTL = 3.41 ± 0.98; GDA/ MTL combination = 3.29 ± 0.91), including the current format used in Malaysia (3.16 ± 0.85). These findings suggest that the preferred NIP format does not necessarily lead to correct interpretation of the nutrition information. The current format should be further promoted and explained to the public to improve its usage and consumer understanding.
Introduction: The implementation of front-of-pack (FOP) energy icon labelling helps
consumers in making good food choices. This is the first study in Malaysia focusing
on such labelling since it was launched in 2012. It was aimed at determining the
awareness and understanding of the FOP energy icon on food labels in Malaysia.
Methods: A total of 366 consumers aged 18-60 years old in the state of Negeri
Sembilan participated in the study. A guided, self-administered survey was
conducted using a convenient sampling method. Results: The results showed
that 85% of consumers surveyed were aware of FOP energy icon. Among those
who were aware of the icon, 50% (n=155) were categorised as ‘excellent’ and 41%
(n=128) categorised as ‘good’, for understanding the FOP. Conclusion: This study
indicated that the icon could be viewed as a potential tool to be used in conjunction
with the nutrition information panel (NIP). Most of the respondents could extract
nutrition information from the FOP (energy) icon. The study showed that those who
had understood the icon were in the group categories of high education, youth
and female. There was also no significant association between those who received
nutrition labelling education and level of understanding nutrition information from
the icon. Therefore, it is important to further explore the possibility the beneficial
impact of FOP labelling system, including consumer education aspects.
Introduction: A retrospective study was conducted with the aim of determining
the factors that affect weight loss among post-bariatric surgery patients. Methods:
A successful weight loss outcome in this study was defined as achieving at
least 50% excess weight loss (EWL). Eligible participants were those who had
undergone bariatric surgery at least two years prior to the study. Adherence to
lifestyle recommendations post-bariatric surgery, binge eating, depression, and
social support were assessed. Results: A total of 51 post-bariatric surgery patients
were recruited with a mean post-operative period of 3.2±0.7 years. The mean preoperative weight of 116.6±28.8 kg and body mass index (BMI) 45.2±8.8 kg/m2 were
significantly reduced to 86.6±21.0 kg and 33.6±6.7 kg/m2, respectively, during
follow-up (p
Introduction: The aging population is a matter of global concern. Age-related
physiological, pathological, psychosocial, economic, cultural and environmental
changes are common and may greatly influence the quality of life of the elderly.
The aim of this review was to explore the determinants and motivations that drive
the elderly in making food choices. Methods: The search strategy of this literature
review used the PRISMA protocol. Potential literature that was related to food
choices was identified using two different combinations of keywords and two major
electronic search engines, namely Pubmed and Science Direct. The articles that
were selected for this review had to be in the English language, open-accessed and
published between January 2007 and December 2017. Results: From a search of
1398 articles, 15 articles (seven quantitative and eight qualitative) were identified
that were related to food choices among the elderly. The key factor that determined
food choices among the elderly population was identified to be health. Others
included convenience, sensory appeal, price, early food experience and more. The
limitations of these studies that were reported were the small sample size and the
reliance on self-reporting. The conclusions that were drawn were for specific groups
that were studied in this review should be extrapolated or generalised with caution.
Conclusion: Strategies for intervention programmes should be undertaken in
collaboration with health professionals, researchers, policymakers, and the food
industry. Future research is needed in the elderly who have chronic diseases, are
dependent or who have disabilities.
Introduction: A compromised quality of life (QOL) as a result of haemodialysis
(HD) is a rising global issue. Elderly HD patients face more challenges than
younger counterparts. This study determined the association of socio-demographic
characteristics, nutritional status, risk of malnutrition and depression with QOL,
among elderly HD patients. Methods: A cross-sectional study was conducted
among 112 HD elderly patients in selected dialysis centres in Selangor, Malaysia.
The patients completed interview-based questionnaires on socio-demographic
characteristics, risk of malnutrition (Dialysis Malnutrition Score, DMS), depression
(Patient Health Questionaire-9, PHQ-9) and QOL (KDQOL-36). Anthropometric
measurements, 24-hour dietary recall and food intake information were obtained
from them and biochemical data from their medical records. Results: Just over half
(50.9%) of the patients had a normal body mass index while 85.7% had optimal
albumin levels. The proportion of patients who met the recommended energy and
protein intakes were 19.0% and 3.4%, respectively. Patients were at moderate risk
of malnutrition, had minimal depression level and perceived better QOL in terms of
effects and symptoms of kidney disease. There was a significant positive correlation
between protein intake and the physical domain of QOL (p=0.02) and negative
correlation between risk of malnutrition with physical and mental composites of
QOL (p
Introduction: The primary reason that compels working mothers to decrease their
ability to continue to breastfeeding successfully is their return to work. Attempts
to continue breastfeeding at work encounters several difficulties. This study
aims to provide an overview of the workplace environment and how facilities at
the workplace affect breastfeeding in Indonesia. Methods: We used a qualitative
approach to provide a detailed picture of the influence of workplace support for
working mothers to perform breastfeeding. We enrolled working mothers (n=18)
in Jakarta, as participants and obtained the following information from them:
parity, type of family and type of work. Results: The findings provided the general
overview of the workplace environment and identified three factors that affected
breastfeeding: seeking information during pregnancy, expression of breast milk at
office facilities and the problem faced by working mothers. Conclusion: Although
the breastfeeding performance of most working mothers in this study comprised
exclusive breastfeeding, some fed their infants with formula milk. This study
suggests that working mothers who continue to breastfeed after returning to work
need the support of their employers, co-workers and others in the workplace to
ensure the provision of health facilities and the protection and dissemination the
rights of breastfeeding working mothers that might lead them to discontinue their
breastfeeding practice.
Dietary intakes and lifestyle habits during adolescence may predict the occurrence of obesity and other diet-related chronic diseases later in life. The purpose of this study was to determine dietary intake of adolescents in a fishing community in Tuaran District, Sabah. A total of 199 apparently healthy adolescents comprising 94 male and 105 female subjects were purposively selected for the study. The mean age of the subjects was 15.2 f 2.2 years with female subjects having a higher mean age of 15.7 f 2.4 years compared to the males (14.6 k1.8 years). The mean BMI of the subjects was 18.4 f 2.9 kg/m2 with females having a significantly higher BMI (18.9 f 2.8 kg/m2) than the males (17.8 f 3.0 kg/m2). Based on the WHO classification (WHO, 1995), 19.6% of the subjects could be classified as thin while 4.5% were at risk of overweight. Overall for both sexes, intake of energy and most nutrients were below the Malaysian recommended nutrient intake (RNI) levels for adolescents, with the exception of vitamin C and niacin. The male subjects showed higher mean intake for vitamin A, thiamine, niacin and vitamin C than the females. Calcium and iron intake ranked among the lowest levels, at 33.4% and 47.2% respectively of the RNI values for both sexes. The main sources of energy were rice, flour products and tubers while fish and seafood were the chief sources of protein. Majority of the subjects (84%) reported taking breakfast daily, which often consisted of fried noodles, fried banana, doughnuts and coffee. Consumption of snacks was popular and commonly consumed snacks were bread, biscuits, and fried banana. The present study revealed that 25.5% and 14.3% of the male and female adolescents respectively were thin, with majority of them consuming inadequate levels of energy and several key nutrients. The results underscore the need for adolescents to be targeted for nutrition and health education as they go through a period of marked physical, physiological and psychological changes.
INTRODUCTION: University students are potentially important targets for the promotion of healthy lifestyles as this may reduce the risks of lifestyle-related disorders later in life. This cross-sectional study examined differences in eating behaviours, dietary intake, weight status, and body composition between male and female university students.
METHODOLOGY: A total of 584 students (59.4% females and 40.6% males) aged 20.6 +/- 1.4 years from four Malaysian universities in the Klang Valley participated in this study. Participants completed the Eating Behaviours Questionnaire and two-day 24-hour dietary recall. Body weight, height, waist circumference and percentage of body fat were measured.
RESULTS: About 14.3% of males and 22.4% of females were underweight, while 14.0% of males and 12.3% of females were overweight and obese. A majority of the participants (73.8% males and 74.6% females) skipped at least one meal daily in the past seven days. Breakfast was the most frequently skipped meal. Both males and females frequently snacked during morning tea time. Fruits and biscuits were the most frequently consumed snack items. More than half of the participants did not meet the Malaysian Recommended Nutrient Intake (RNI) for energy, vitamin C, thiamine, riboflavin, niacin, iron (females only), and calcium. Significantly more males than females achieved the RNI levels for energy, protein and iron intakes.
CONCLUSION: This study highlights the presence of unhealthy eating behaviours, inadequate nutrient intake, and a high prevalence of underweight among university students. Energy and nutrient intakes differed between the sexes. Therefore, promoting healthy eating among young adults is crucial to achieve a healthy nutritional status.
This study aimed to evaluate the validity and reliability of the Multidimensional Body Image Scale (MBIS), a seven-factor, 62-item scale developed for Malaysian female adolescents. This scale was evaluated among male and female Malaysian university students.
Introduction: A vegetarian diet is generally considered as healthy for preventing metabolic-related diseases. There is lack of studies in Malaysia comparing the nutritional status of vegetarians and non-vegetarians. This cross-sectional study aims to compare body weight status, dietary intake and blood pressure level between these two groups. Methods: A total of 131 vegetarians and 135 non-vegetarians were recruited using convenience sampling from a Buddhist organisation in Kuala Lumpur. Body weight, height, waist circumference, percentage of body fat, and blood pressure measurements were taken, while dietary intake was assessed using a 2-day 24-hour dietary recall. Results: More vegetarians were underweight than non-vegetarians (31.3% vs 15.6%), while prevalence of overweight and obesity was higher among the non-vegetarians (23.7% vs 9.9%). A higher proportion of nonvegetarians (34.1%) had an unhealthy range of body fat percentage and significantly higher risk of abdominal obesity (24.4%) than the vegetarians (19.1% body fat; 13.7% abdominal obesity). Mean intakes for protein and fat were significantly lower among the vegetarians, while no significant differences were observed in the mean intake for energy and carbohydrate. Vegetarians had significantly higher intakes of vitamins C, D and E, calcium, potassium and folate, while vitamin B12 intake was significantly higher in the non-vegetarians. More non-vegetarians presented with unhealthy blood pressure status. Conclusion: Vegetarians in this study generally showed healthier dietary intake and lower body fatness than the non-vegetarians. Studies are suggested to be undertaken on a bigger sample size of vegetarians to confirm these findings.
Selenium is an essential trace mineral that is required for many physiological functions in animals and the potential relevance of selenium to the reproductive system of livestock has been considered by many researchers. The objective of this study was to examine the effect of selenium supplementation on the spermatogenic cells of goat. Eight young male crossbred (Katjang x Boer) goats, aged between 9 to 11 months, were used in this study. The control group (CON; n = 4) was fed with a diet consisting of 60% Guinea grass and 40% concentrates while the treatment group (Se-SUP; n = 4) was fed with the same diet as the goats in the control group but with supplementation of 0.6mg selenium (sodium selenite powder) per goat daily for 100 days and were slaughtered on the 101st day. There were no significant differences (p>0.05) in the mean number of spermatogonium, spermatocytes, spermatozoa and the total number of spermatogenic cells between the CON and Se-SUP goat respectively. However, there was a significant increase (p< 0.05) of spermatid in Se-SUP goats. The mean percentage of spermatids was significantly increased (p< 0.05) while spermatozoa was significantly decreased (p< 0.05) in Se-SUP goats. In conclusion, selenium supplementation increased the percentages of spermatids and decreased the percentages of spermatozoa in the seminiferous tubules in goats.
Introduction: Self-efficacy for eating predicts successful weight loss and maintenance in Type 2 Diabetes Mellitus (T2DM) individuals. The Weight Efficacy
Lifestyle (WEL) questionnaire determines self-efficacy for controlling eating. This study aims to validate the Malay-translated version of the WEL questionnaire and
to establish the cut-off scores to define the level of eating self-efficacy in Malaysian T2DM individuals.
Methods: A total of 334 T2DM individuals, aged 55.0±9.0 years, were recruited from a primary healthcare clinic based on sampling ratio. Medical records were reviewed for eligibility. Inclusion criteria included BMI ≥23kg/m2, and no severe diabetes complications. The WEL questionnaire assessed eating resistance during negative emotions, food availability, social pressure, physical discomfort and positive activities, and was back translated into Malay language. Self-efficacy was rated on a 0-9 scale with higher WEL scores indicating greater self-efficacy to resist eating. Factor analysis established the factor structure of the WEL questionnaire. Inter-item and item-total correlations determined construct validity while internal consistency described the reliability of the structure.
Results: A two-factor structure accounting for 49% of variance was obtained, and it had adequate reliability, as indicated by Cronbach’s α of 0.893 and 0.781 respectively. Item-total correlations of r>0.700, p<0.01 and inter-item correlations of r<0.500, p<0.01 demonstrated construct validity. Cut-off scores of ≥44 and ≥32, respectively for factor one and two defined high eating self-efficacies in T2DM individuals.
Conclusion: The Malaytranslated version of the WEL questionnaire appears to be a valid and reliable tool to assess self-efficacy for controlling eating behaviour in Malaysian T2DM population.
Keywords: Diabetes, eating self-efficacy, Malay, reliability, validity
Microalgae can produce various natural products such as pigments, enzymes, unique fatty acids and vitamin that benefit humans. The objective of the study is to study the bioaccessibility of carotenoids (β-carotene and lycopene) and vitamin E (α- and β-tocopherol) of Nannochloropsis oculata and Chaetoceros calcitrans. Analyses were carried out for both the powdered forms of N. oculata and C. calcitrans, and the dried extract forms of N. oculata and C. calcitrans. In vitro digestion method together with RP-HPLC was used to determine the bioaccessibility of carotenoids and vitamin E for both forms of microalgae. Powdered form of N. oculata had the highest bioaccessibility of β-carotene (28.0 ± 0.6 g kg-1), followed by dried extract N. oculata (21.5 ± 1.1 g kg-1), dried extract C. calcitrans (16.9 ± 0.1 g kg-1), and powdered C. calcitrans (15.6 ± 0.1 g kg-1). For lycopene, dried extract of N. oculata had the highest bioaccessibility of lycopene (42.6 ± 1.1 g kg-1), followed by dried extract C. calcitrans (41.9 ± 0.6 g kg-1), powdered C. calcitrans (39.7 ± 0.1 g kg-1) and powdered N. oculata (32.6 ± 0.7 g kg-1). Dried extract C. calcitrans had the highest bioaccessibility of α-tocopherol (72.1 ± 1.2 g kg-1). However, β-tocopherol was not detected in both dried extract and powdered form of C. calcitrans. In conclusion, all samples in their dried extract forms were found to have significantly higher bioaccessibilities than their powdered forms. This may be due to the disruption of the food matrix contributing to a higher bioaccessibility of nutrients shown by the dried extract forms.
Microalgae can produce various natural products such as pigments, enzymes, unique fatty acids and vitamin that benefit humans. The objective of the study is to study the bioaccessibility of carotenoids (β-carotene and lycopene) and vitamin E (α- and β-tocopherol) of Nannochloropsis oculata and Chaetoceros calcitrans. Analyses were carried out for both the powdered forms of N. oculata and C. calcitrans, and the dried extract forms of N. oculata and C. calcitrans. In vitro digestion method together with RP-HPLC was used to determine the bioaccessibility of carotenoids and vitamin E for both forms of microalgae. Powdered form of N. oculata had the highest bioaccessibility of β-carotene (28.0 ± 0.6 g kg-1), followed by dried extract N. oculata (21.5 ± 1.1 g kg-1), dried extract C. calcitrans (16.9 ± 0.1 g kg-1), and powdered C. calcitrans (15.6 ± 0.1 g kg-1). For lycopene, dried extract of N. oculata had the highest bioaccessibility of lycopene (42.6 ± 1.1 g kg-1), followed by dried extract C. calcitrans (41.9 ± 0.6 g kg-1), powdered C. calcitrans (39.7 ± 0.1 g kg-1) and powdered N. oculata (32.6 ± 0.7 g kg-1). Dried extract C. calcitrans had the highest bioaccessibility of α-tocopherol (72.1 ± 1.2 g kg-1). However, β-tocopherol was not detected in both dried extract and powdered form of C. calcitrans. In conclusion, all samples in their dried extract forms were found to have significantly higher bioaccessibilities than their powdered forms. This may be due to the disruption of the food matrix contributing to a higher bioaccessibility of nutrients shown by the dried extract forms.
This is a descriptive study on nutritional status of Orang Asli (Che Wong tribe) adults in Krau Wildlife Reserve. Twenty-six households, comprising 29 men and 28 women,participated in the study. Dietary diversity was assessed using food frequency questionnaire with 37 food groups. Weight, height and waist circumference were measured using standard instruments. The mean age for men and women was 39.9 ± 17.1 years and 33.7 ± 16.1 years, respectively. Most (89.5%) of the adults had no formal education and about 89.5% of households were categorised as poor. There were 13.8% underweight, 72.4% normal, 10.3% overweight and 3.3% obese men. For women, 25.0%, 46.4%, and 28.6% were underweight, normal and overweight, respectively. While none of the men had at-risk waist circumference (men >90 cm), about 21.4% of women had waist circumference of >80 cm. The mean dietary diversity score was 9.47 ± 4.15 with men (9.48 ± 3.70) and women (9.46 ± 4.63) having similar scores. There was a significant correlation between waist circumference and household income (r=0.36, p< 0.01); however, the association was only significant in women (r=0.50, p< 0.01). Although under-nutrition still prevails, there are emerging cases of overweight and obesity in this rural Orang Asli community undergoing nutrition transition especially among the females.
Male Malin x Polled Dorset crossbred sheep were stall-fed with grass (10%) and PKC (90%) and supplemented with either zinc at 500 ug/g, as zinc sulfate (PKC+Zn group) or zinc (113 ug/g) and ammonium molybdate (500 ug/g) (PKC+Zn+Mo group) or unsupplemented diet (PKC group) for 20 weeks. Another group which acts as a control was fed with a diet consisting of corn and fish meal (2 0%) and grass (80%). The animals were monitored daily and the body weights were recorded at a period of two weeks intervals throughout the trial. Blood samples were also collected for mineral analysis. At the end of the trial the animals were slaughtered. The carcasses were examined for gross lesions, whilst the right liver lobes and renal cortex were isolated for histopathological evaluation and mineral analysis. All animals in the PKC group died before the end of the trial with the main clinical signs of generalised jaundice and haemoglobinuria. The kidneys were firm, enlarged and reddened or darkened. Histologically, the hepatocytes were swollen, vacuolated and necrotized, particularly at the periacinar zone. Hepatic fibrosis was observed at the periportal zone. Cellular swelling, vacuolation and necrosis were found in the tubular epithelial cells of the renal cortex. Neither clinical signs nor gross or remarkable histological lesions were observed in the other groups of animals. The hepatic, renal and blood copper levels In the PKC group were elevated when compared to the control. Addition of zinc either with or without ammonium molybdate in PKC diet inhibit the copper content in the organs, however the zinc contents were increased. The average daily gain of the PKC group was remained consistent to those of the other groups, except it was reduced starting at about 1 to 2 weeks prior to death. It was concluded that feeding PKC In excess in sheep can cause chronic copper toxicity. However, this effect can be prevented by dietary zinc supplementation either with or without ammonium molybdate.
Thirty, 4 month-old male Maim x Polled Dorset crossbred sheep were allocated into 6 groups of 5 animals each. Four groups of animals were stall-fed with basal diet of 90% palm kernel cake (PKC) and 10% grass (G) for 16 weeks. One group of the animal was slaughtered at the end of the 16 weeks feeding trial (PKC group), whilst the other three groups were further fed with either the same diet (PKC+PKC group) or fed with a new diet consisting of 30% corn and 10% fish meals (CF) and grass (60%) either with (PKC+CF+Zn group) or without (PKC+CF group) zinc supplementation (500 mg/g Zn as zinc sulfate) for another 16 weeks and were slaughtered at the end of the feeding trial, The other two groups which act as controls were fed with corn (30%) and fish meals (10%) and grass (60%), and were slaughtered at weeks 16 (CF group) and 32 (CF+CF group) of the trial. The blood, right and left liver, renal cortex and medulla, pancreas, bile and urine of all animals were analysed for copper and zinc contents using an atomic absorption spectrophotometer. The liver and kidney were also fixed in 10% buffered formalin for histopathological examination. The study showed that neither clinical signs nor gross lesions of copper or zinc toxicity were observed throughout the trial. However, the copper concentration in both the right and left liver of PKC fed sheep at weeks 16 and 32 rose to about 3 times that of the controls and remained high in both the PKC+CF and PKC+CF+Zn groups. A similar pattern of copper concentration was observed in the blood. The copper and zinc contents in the renal cortex and medulla, pancreas, bile and urine remained low in all groups. The zinc content in the liver of PKC+CF+Zn group was significantly increased. Histologically, moderate hepatic lesions were observed in the PKC fed sheep at week 32. The lesions were milder in the other groups especially in the PKC+CF+Zn group. No significant renal lesions was recorded in all groups. It was concluded that the usage of dietary zinc supplementation (500 mg/g) in the treatment of PKC toxicity in sheep was unsatisfactory. The ability of Malin x Polled Dorset crossbred sheep to tolerate the high copper content in PKC at least during the first 16 weeks of the feeding trial may provide more avenue in the utilization of PKC as a major feed ingredient in sheep.
The aim of this study was to investigate the relationship between gender, birth weight, nutritional status, and iron status of children with their academic performance and cognitive function.
Iron deficiency and anaemia affect millions of children worldwide. This study aimed to investigate the effect of iron deficiency with or without anaemia on cognitive functions, specifically with short-term memory, attention and visual motor coordination in children. A total of 173 primary school children was enrolled. Cognitive functions were assessed using the Wechsler Intelligence Scale for Children. Three sub-tests were selected to assess processing speed (coding test), immediate auditory memory (digit span test) and visual processing and problem solving ability (maze test). The results showed significant correlation between age and coding test (r =0.38, p< 0.001), digit span test (r =0.16, p = 0.028), and maze test scores (r =0.28, p< 0.001), and the total sub-test scores (r=0.43, p < .001). After age adjustment of the cognitive function tests, iron deficient children without anaemia scored significantly lower than the healthy children (p< 0.001) on coding test, while iron deficient children with anaemia and iron deficient children without anaemia scored significantly lower (p< 0.001) than the healthy counterparts on maze test. No significant differences were observed on digit-span score among the groups. This study confirms the negative effect of both iron deficiency and iron deficiency anaemia on processing speed and visual motor coordination in children.